Many new medical students wonder when they should begin studying for the first of three licensing exams – the USMLE Step 1. There are a lot of opinions out there regarding how long students should be preparing for this exam, and I thought I would write about what I think and also what I recommend doing from the beginning.
When new medical students ask upper year students when they should begin preparing for the USMLE Step 1, they might receive a number of responses. “Don’t start yet, it’s too early”. “Wait until your second year of medical school”. “Start using board resources right away”. “You should only need the length of time your school gives you for your ‘dedicated'”. Here are my thoughts on the matter. You are attending medical school – for all of basic sciences – to learn the material you need to know for the licensing exams. It’s as simple as that. The material that you are being taught in your basic sciences program is the material that you either need to know directly (e.g., what biochemical process is impaired in Marfan disease) or indirectly to support what you need to know directly (e.g., why do people with Marfan disease have vascular involvement).
When people say that students don’t need to “start studying for boards” at the beginning of medical school, I think they are giving very misguided advice. For one, if you begin thinking about your medical school curriculum as preparation from the very beginning, then you will make a concerted effort to understand and commit the material to memory so you don’t have to cram in your actual dedicated period. And secondly, the information we are taught during the first year of medical school is just as important to know and understand as the material we are taught in our second year of medical school. If you don’t start thinking about it seriously at the time you are taught it, you’ll have to cram it some time later. So, why would we only start framing our studying as board preparation come second year?
Here are my tips to make it very doable to begin studying for your Step 1 exam from the very beginning, and end up very prepared when the time comes to take it!
Use First Aid As a Study Guide
There is A LOT of material that we are responsible for learning from the get go and, admittedly, it’s not all very high yield. This is where the First Aid book comes in very handy. Here is how I recommend using it from day one. First Step: For every lecture you have, cross-reference the material with that included in First Aid. Second Step: Master the overlapping material that is covered in First Aid first, and then study the remaining material from your lecture. This way you ensure that you are, at minimum, learning the high yield material that you NEED to know for the USMLE.
The First Aid book is a very bulleted version of the material that we are responsible for learning, so I highly recommend learning the why and how of each lecture item that overlaps with First Aid. The USMLE is not testing your ability to memorize and regurgitate the facts out of First Aid. They are testing your ability to understand the material and apply it. Given this, I began annotating my First Aid book during my second semester of first year to detail the why and how of the information that is listed.
Find a Video or Text Resource
Sometimes the lecture material provided by your school may not be enough for you to conceptualize some topics. This is where other third party resources come in very handy. Many students enjoy and benefit from using a video resource, such as Sketchy Medical, Physeo, Boards & Beyond, etc. Other students may prefer using a textbook or other text resource, such as AMBOSS, where they are free to read the material at their own pace. Whichever your preference – and this may be different for each course – find a resource that works for you for each class and stick with it. Based on what you learn from your chosen resource, you can also annotate in your First Aid to add those details that were missing before you understood the concept.
Use a Form of Spaced Repetition
This here is absolutely key!!! It is not enough to simply learn a concept once, and move on from it to the next topic and expect to retain everything you learn of that first concept until you need it for the exam. Memory just doesn’t work like that…for most of us. This is why spaced repetition is critical to implement in medical school. This can be achieved in several different ways. One of the most popular choices that medical students use is Anki. If you haven’t heard of Anki, it’s a free flashcard app that uses an algorithm to display the flashcards that you didn’t know as well (per your own self-evaluation) and need to see sooner than other cards. It basically does all of the planning for you, and you just need to study the cards it decides to show you. You can find plenty of tutorials on how to use Anki on YouTube. Another popular resource is Quizlet. There are many premade flashcard decks that you can find for whatever topic or course you are studying, or you can make your own flashcards. Yet another method that students may use is simply a pen and paper! Write down briefly the topic that you need to remember and then challenge yourself to recall every detail. Then recall the information again the next day before looking at the page, and correct yourself as needed. Then repeat the process a few days later, and then a week later. You can adjust the time spacing to your needs, but the general concept remains the same.
Find a Question Bank to Apply What You’ve Learned
One of the most popular question banks that medical students use is UWorld. I, personally, don’t think you need to be using UWorld from the beginning of medical school. I would reserve this for a few months out from your Step exam. I say this because it’s a very expensive resource, firstly, and there are a lot of other great practice question resources out there that will suffice instead. Some of the practice question resources I recommend using during your basic sciences curriculum are as follows:
- USMLERx: very similar content/topics tested as the NBME exams
- BRS chapter questions as well as practice exams as the end of each book: again, very similar style to the NBME exam questions
- Boards & Beyond also has a great bank of questions, but I didn’t use it as much
- AMBOSS: these questions are trickier to figure out what is going on but, once you do, the answer choices seem more straight forward; I would use this once you are confident with the topic in another practice question resource
Aside from practicing recall of the material using spaced repetition, practicing applying your newly learned content is also a critical step in studying during medical school. You can’t always predict the way a patient presentation will be described or what exactly the question will be asking you about a topic, so it’s important to see as many examples as possible before the real deal.
An important thing to keep in mind with practice problems is that you need to view your performance as a learning opportunity, as opposed to assessing your standing. A lot of the practice problems are very challenging and it can be very disheartening sometimes seeing your “score” on a practice set. So, change your perspective from “I’m performing terribly” to “What have I learned from this?” and “Wow, I know so much more now than I did an hour ago!” In order for this to be effective, you need to be sure to read the correct answer explanations and ALSO the incorrect answer explanations, so that you develop an understanding of why the question you chose was the incorrect answer (if you chose incorrectly). Read the correct answer choice explanation even when you chose correctly to ensure your reason for selecting the answer was for the correct reason. This is where spaced repetition meets application practice. When you get a question wrong, or happened to guess correctly, find a way to incorporate your newly learned material into your spaced repetition routine.
Let’s Wrap This Up…
Building a strong foundation during the basic sciences is crucial and will set you up for success when it comes time for your dedicated study period for Step 1. If you approach your medical school curriculum as an important aspect of your board exam prep, then you are likely to succeed later on and you’ll thank yourself for starting as soon as you did!
Stay tuned for my suggestions for studying during your review term, if your medical school incorporates this. As always, feel free to email me at slp.to.md@gmail.com with any questions. Thanks for reading 🙂
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